Important News

As a part of our continuing efforts to improve service to our members, FEP is making some system improvements related to Coordination of Benefits.

For claims received by FEP on or after May 15, 2010, if the Medicare or Other Commercial Carrier payer information is missing on the claim, the claim will receive a total denial. Providers will then re-file an original claim (not a corrected claim) with the Medicare/Other Carrier payer information included on the claim.

This is a change from our current policy. Currently, FEP makes a zero payment on the claim. In response to a zero paid claim, FEP currently accepts the missing other carrier payment information in the following forms:

Only an EOB without a claim

An EOB attached to an inquiry

An EOB attached to a copy of the NOP

a claim electronically re-filed as a corrected claim with the EOB information

FEP uses this information and makes an adjustment to the zero paid original claim.

Effective May 15, 2010, FEP will not accept the following:

Only an EOB without a claim

An EOB attached to an inquiry

An EOB attached to a copy of the NOP

A claim that was denied as above and not re-filed as an original claim

Under the new process these situations will be returned to the provider to file an original claim with the appropriate payer information submitted on the claim.

The new process will apply to both electronic and paper claims.

For electronic filers, the claim should be resubmitted electronically as an original claim, with the Medicare/Other Payer information on it.

For providers who cannot submit electronically, a paper claim should be submitted as an original claim, with the Medicare/Other Carrier EOB information on it.

Please do not submit as a corrected claim, or submit on paper if you can file electronically, as these situations will substantially delay processing of your claim.